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New Prostate Cancer Therapy Promises Fewer Side Effects

Aaron Bacher, 69, was diagnosed with prostate cancer more than 13 years ago. &ldquo;I felt the same things that most men feel when they hear the news,&rdquo; Bacher, 69, says. &ldquo;It&rsquo;s shock. It&rsquo;s concern. It&rsquo;s fear.&rdquo; (Chris Young for The Toronto Star)

Thu., Nov. 1, 2012

By: Jaclyn Tersigni

It’s been more than 13 years since Aaron Bacher was told he had prostate cancer, but he still remembers the moment.

“I felt the same things that most men feel when they hear the news,” Bacher, 69, says. “It’s shock. It’s concern. It’s fear. It’s all these things that you didn’t expect to feel because you never expected to hear that you have prostate cancer.”

For Bacher, the diagnosis was part of a double whammy. That same day, he was told he’d need to have quadruple bypass surgery.

“I thought more of the heart situation being a life-threatening situation than the prostate cancer. The urologist kept telling me it was a very early diagnosis. There wasn’t that much cancer. It wasn’t aggressive. And it was very treatable and curable.”

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Prostate cancer is the most common cancer among Canadian men, with the exception of non-melanoma skin cancer. But, according to Dr. John Trachtenberg, “the vast majority of men who have prostate cancer probably die with it, not because of it.”

Trachtenberg holds the Fleck Tanenbaum Chair in Prostatic Diseases at the University of Toronto and University Health Network and is the director of the Prostate Centre at Princess Margaret Hospital in Toronto. He’s been researching prostate cancer for 30 years, with a particular interest in finding a therapy that falls between doing too little and doing too much.

“Our thought for about 10 years now has been: Is there some form of intermediate treatment?” Trachtenberg says. “Is it possible to eliminate only the tumour itself without damaging the tissue around it, and thereby eliminate the side effects?”

Enter Focal Laser Thermal Therapy (FLTT), a relatively new treatment that Trachtenberg has been researching and developing at Princess Margaret Hospital.

During the procedure, a laser fibre is inserted through the perineum to heat the tumour to a point where it can’t survive. Because doctors can monitor the temperature of the tissue in real time, they can ensure that while the tumour is targeted with damaging heat, the nearby urethra and nerve bundles responsible for sexual activity stay at a safe temperature and therefore remain undamaged.

When Bacher met with his urologist in the fall of 1999 – just a few months after having his bypass operation – the doctor’s first recommendation was surgery, a treatment that comes with a fairly lengthy recovery time and potentially debilitating side effects.

“I was still working on getting over the surgery I just had four or five months before. So, psychologically, I don’t think I was ready for another major operation. I basically said to him, ‘I hope you have Plan B for me,’ ” Bacher says.

Fortunately, his prostate cancer wasn’t very aggressive and had a fairly low score on the Gleason grading system (which rates the aggressiveness of prostate cancer tissue based on how it looks under a microscope). A specialist at Sunnybrook recommended brachytherapy, a form of internal radiation.

Bacher had one brachytherapy treatment in February of 2000 and has been cancer-free since. “[It was] the same morning my second grandson was born,” he says. “So, every time he celebrates a birthday, so do I.”

Recovery time after brachytherapy is minimal and Bacher only experienced one side effect. “It corrected itself. When it happened about six months later, I spoke to the doctor and he said, ‘Let’s give it time and see what happens.’ And eventually everything turned back to the way it was.”

Not all men are as lucky. Surgery and radiation – both common treatments for prostate cancer – can cause unpleasant, life-altering side effects.

“The side effects of traditional surgery are incontinence and impotence. The side effects of radiation are impotence and bowel dysfunction,” Trachtenberg says. “Both of these treatments have quality-of-life-impairing side effects.”

These side effects are one reason why Trachtenberg is so passionate about FLTT. “Our aim is just to destroy the tumour itself and leave all the normal tissue around it – that you need for erections, that you need for continence, that you need to keep your bowels normal –completely normal,” Trachtenberg says. “As you’re destroying the tumour, you can actually see that the other tissues are not being damaged at all.”

FLTT has been in clinical trials at Princess Margaret Hospital since January 2010. Since then, about 50 men with low- to intermediate-risk cancer have been treated, with good results.

“We’ve had uniformly terrific outcomes. . . . We’ve had essentially no side effects in anyone,” Trachtenberg says. “In general, about three-quarters of the people had been free of tumours in the area we’ve treated. It’s not 100 per cent. In general, half of all people have not shown any progression.”

Trachtenberg says he hopes that if FLTT is proven effective for low- to intermediate-risk cancers, it can be used on people with higher-risk forms of the disease.

FLTT isn’t yet ready to be declared an official treatment option. This current phase of trials should wrap up within six months before moving onto the next phase. “We’re hoping to start a Phase 3 trial to be able to demonstrate how effective it is relative to conventional therapy,” Trachtenberg says. “I’m very hopeful that it will show real benefits.”

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